Narcotics research, rehabilitation, and treatment. Hearings, Ninety ...

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:188number as that on the bottle. When the large bottle is emptied, the envelopecontaining the NTA forms 6, showing total disbursements (1,000 cc. ) will besealed and returned to Information Central via messenger. The forms in theenvelope will tell the pharmacist the date, the dosage level, and names of thepatients who were served out of that particular bottle. All doses of methadonedispensed must be strictly accounted for at all times.C DiscrepanciesNTA form 14, "Director's Discrepancy Notice" (see attachment 8) will beused to notify the physician of any discrepancies in recordkeeping or NTA proceduresas noted by the computer.The following are some items which may be noted :1. Dosage level higher than that prescribed by the physician.2. Irregular dosage level.3. Consistently dirty urine.4. No physical examinations within 30 days of initial intake.5. Discrepancy in methadone medication disbursement.6. Lack of proper patient evaluation.7. Apparent lack of patient progress.8. Exception to take-home medicine policy.D. Confidentiality of recordsThe Narcotics Treatment Administration respects the basic right of patientsto have all information and treatment records maintained with strict confidentiality.NTA regards this effort as vital to the establishment of an effective treatmentrelationship with its patients.For this reason, only Information Central is authorized to release informationon patients to vertified requestors. With the exception of criminal justice andcivil commitment patients and patient-employees, no information on any patientwill be released unless1. The patient has signed and Information Central has received NTAform 28 "Patient Consent for Release of Treatment Information" (seeattachment 9) specifically authorizing the requestor access to information:2. Information Central has received the request for information in writing; and3. Information Central has verified the current status of the patient visa-visthe requestor.Criminal justice system patients are those who have been formally referredto NTA by the police, courts. Department of Corrections, or parole board as acondition of release to the community. Requests for information on these patientsby the agency must be honored immediately by the program chief or his designee.The request and the response should preferably be made in writing and thecurrent status of the patient vis-a-vis the requestor verified before the informationis released. Information should be released in the form of treatment summarieswhenever possible.Civil commitment patients are those brought to an NTA facility under signedpickup orders by the Narcotics Squad of the Metropolitan Police Department.The results of their diagnostic evaluation and determination of their treatmentstatus is automatically forwarded to the referring agency—the MetropolitanPolice Department.Patient-employees are staff members of NTA who also remain in a treatmentstatus with NTA. They will be required, as a condition of employment, to remainfree of illegal drugs, and must agree to release information on their urinesurveillance reports and pertinent medical summaries to their immediate supervisors,program unit chiefs, and the coordinator of counselors. Such informationwill not be shared with other staff members but can be used as a basis fordisciplinary action or suspension of employment if confrontation does not resultin termination of illegal drug use.Minors under 21 years of age should be encouraged to authorize a parent orguardian to receive at least a summary statement of their treatment status.Emerfjcneirs arising when an NTA patient is confined because of arrest, illnes.s,or accident will receive immediate attention. Every effort will be made toassure the patient immediate medical assistance to maintain his medicationlevel for the duration of the emergency upon request from the medical authoritiesattending the patient.
189Attachment OneInformed Consent to Take Methadone Treatment in the NarcoticsTreatment AdministrationI, , understand that methadone treatment for chronic heroinaddiction and its consequences is a new use of an established drug. I furtherunderstand that methadone is a powerful and addictive narcotic drug and thatif I stop taking it I will experience serious withdrawal symptoms. Althoughmethadone treatment has been used successfully by thousands of people throughoutthe country, I also understand that the long-term effect of this drug onhumans is not entirely known at this time.I willingly give my informed consent to take methadone under the carefulsupervision and control of the NTA staff or NTA cooperating agency staff. Inow think that methadone is neces-have tried to stop using illegal drugs and Isary for me to avoid further use of illegal drugs.I have not been forced or pressured into this dec' 'ion. I understand that Ican stop methadone treatment at my own discretion and that the staff mayterminate me at their discretion. If I do stop methadone treatment for anyreason, I understand that for my own safety I should withdraw from methadoneby using gradually reduced doses of the medication under the control of themedical staff.Signature and datePrinted or typed nameNTA patient number"WitnessSignature and dateNTA FORM 19(10-70).Program nameATTACHMENT TWO ,
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NARCOTICS RESEARCH, REHABILITATION,
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::VEXHIBIT NO. 4 (a) AND (b)Eddy, D
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urden that such addiction imposes u
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1 (lata; (->) the sliariiis" oF iii
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9Chairman Pepper. The committee is
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::11quota production from unrecogni
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13in this country. This raises the
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15from other clinical projects of w
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:17practice, experience has indicat
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;19.I think a quota would be better
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21When methadone was first introduc
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:::::.—23American Society of Phar
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_'—25.I'BOCUREMENT AND ISSUE DATA
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'.28Fiscal years-1967 1968 1969 197
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30rally in opium. By indirect, the
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32We can, I think, most helpfully g
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34so intense that we haven't done v
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Dr. Eddy. Well, physicians, usually
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38Dr. Eddy. No.Chairman Pepper. Now
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:40get away with it as Dr. Keats su
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:—:42public health hazard was jud
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:44Bibliography(1 Nathan B. Eddy. "
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46(52) Nathan B. Eddy. "Dilaudid."
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48(98) "The New Narcotics, Post-gra
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^.50
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52entails the consideration of addi
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54Chairman Pepper. Have you found t
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56^.I wonder would you care to comm
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58Chairman Pepper. Without objectio
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—1958-681959-«419691962-64196219
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—62abuse and has brought about th
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64bank robbery or an assault. You d
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66Mr. Wiggins. Would the stopping o
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68—Chairman Pepper. Can you give
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:70The problem then would be the wi
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;72taking exceptional measures in t
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)—74pay serious attention to this
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;76From 1958 to 1961, he served as
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78deine in painkilling drugs. So if
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;80ning capabilities, responsibilit
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;:;82terials. If they could introdu
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84Figure 1infrared Ektachrome film
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;86Figure 3.—Tones of wheat (W) a
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88ers at the poppyfields or at any
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:90;:tional situations has handicap
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;;92Locating illicit opium cropsDet
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94Jaffe. Well, there would be some
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96Mr. Jaffe. Primarily on the fact
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98in the same ball park about what
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100Chairman Pepper. Mr, Waldie, do
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::102agencies and input data would
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104most facilities are barely able
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;106We have also studied a ^roup of
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108Dr. Gearing. Yes, sir; I would n
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110somethino: in the nei
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112program is put into the machiner
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I114you have some data there that s
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116Dr. Gearing. It depends on what
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118Chairman Pepper. Would you have
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120it not be so that we could proje
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.122admission rate was approximatel
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124BESULTS(1) Although many of the
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1262. All the members of the methad
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128HETHADOHE MAINTENANCE TREATMENT
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11 1 1 1 1 11130Methadone Halnten?n
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132TABLE 2.-METHAD0NE MAINTENANCE T
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134Figure 9 Methadone tlaintenance
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136Methadone Ka'ntanance Treatmf:nt
Page 150 and 151: :::.::.138Appendix A^—Methadone M
Page 152 and 153: 140nance treatment patients showing
Page 154 and 155: 142Figure 3 •lethadone Kaintenanc
Page 156 and 157: 144Dr. DuPoNT. 1,760 on methadone m
Page 158 and 159: :146there are dramatic reductions i
Page 160 and 161: 148Health insurance coverage for me
Page 162 and 163: 150Dr. DtjPont. Well, there are no
Page 164 and 165: 152Mr. Blommer. You would agree the
Page 166 and 167: 154done. Where is the evidence ? No
Page 168 and 169: 156There are several reasons a pers
Page 170 and 171: 158It would seem to me a very busy
Page 172 and 173: 160we had before. I don't think it
Page 174 and 175: 162heroin addiction and support all
Page 176 and 177: 164Dr. DuPoNT. I am reluctant to ge
Page 178 and 179: 166Using this figure as rule of thu
Page 180 and 181: )168ment facilities for heroin addi
Page 182 and 183: .170parole departments. None were c
Page 184 and 185: ::172Table 2.— Selected character
Page 186 and 187: 174TABLE 3.—HEROIN ADDICTION RATE
Page 188 and 189: 176W.a^^cc-V.c Cffv..AdF-ro ftcoKjL
Page 190 and 191: 178.^06V f\QrK-'SEt G^ouP/AJ6SIS're
Page 192 and 193: I180*i coo)u->CM>—'CMUJCOO O COa>
Page 194 and 195: I(/I182esiMmin0)^> oo.00 =E|c O.2 o
Page 196 and 197: 184encouraged to return to methadon
Page 198 and 199: 186or other side effects. This incr
Page 202 and 203: 190Attachment ThreeTo all medical s
Page 204 and 205: -jI IALLI192ATTACHMENT- FIVE,J: IPA
Page 206 and 207: 194ATTACHMENT NINEGOVERNMENT OF THE
Page 208 and 209: ......—196half of the addicts sta
Page 210 and 211: 198CONCLUSIONSCertain patterns emer
Page 212 and 213: 200TABLE 5.— PROFILE OF BARBITUAR
Page 214 and 215: 202TABLE ll.-SUPPORT OF HEROIN HABI
Page 216 and 217: 204TABLE 17.-AGE OF ADDICTS AND NON
Page 218 and 219: 206TABLE 23.—PRESENT MARITAL STAT
Page 220 and 221: 208TABLE 28.-MILITARY SERVICEAddict
Page 222 and 223: :210The committee is pleased to cal
Page 224 and 225: 212sists of a network of 21 geograp
Page 226 and 227: 214(6) Basic studies on the nature
Page 228 and 229: 216in fact, constitute autonomous o
Page 230 and 231: Chairman Pepper. Mr. Perito?218;; M
Page 232 and 233: ^'220is not a very forgiving drug.
Page 234 and 235: '222Furthermore, in our present con
Page 236 and 237: —224the Federal Government decide
Page 238 and 239: -—I have presented one generic ki
Page 240 and 241: ,clinic;?,>•
Page 242 and 243: 230I realize we are running late.Do
Page 244 and 245: ''232'']Vir. Winn. Tiien you mentio
Page 246 and 247: 234So having put it in the area, ha
Page 248 and 249: ,Memberships'—i236privilege of co
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;238A central hypothermic response
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;240South Bronx, Bedford-Stuyvesant
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242€are of patient addicts. We ha
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244hospitals in the city, came into
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246that came into my office, and I
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'Mr.;>•/nmo'.i,,;248deputy commis
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:250two Rockefeller Institute physi
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:252during pliase II that serious e
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254well-structured methadone mainte
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;:256nonsense and serves only to ad
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:258you best complete your statemen
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260Mr. Pertto. Based upon your expe
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262A a'reat case in point was a con
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«264Mr. Steiger. Did you discuss w
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—:266Mr. HoRAN. We don't support
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268Mr. Horan, let's back up a littl
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270It is not up to heroin or morphi
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272nesses yesterday who brought out
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274;Mr. Perito. It is my understand
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276So that at the end of the week t
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278steroid he lias in him we might
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280Mr. Perito. You are referriii"'
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282not drug free. I can say approxi
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28 A$2-a-day habit these individual
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•As286I got to the point once in
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288Mr. Steiger. You mentioned anoxi
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290Mr. Eangel. I could see then tha
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292Dr. Casriel. Mr. Keating, I have
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j294What period of time are ^ve tal
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296was March of 1970—he was admit
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298"The paper by Dole and Nyswander
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:300vent them from coming to New Yo
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302[Exhibit No.14(b)]Casriel Instit
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304to result from the insuflScient
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306It is this role of the intervent
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308EESULTSStudies concerning tlie p
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310The method derives from a specia
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312Why is this happening? What need
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m)effective with uncured alcoholics
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I316Casriel, who is medical-psychia
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318resort to heroin. One must not f
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.320in Permanent Cure of Narcotic A
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322!(4) '-Modification of Adaptatio
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324sections of the country, all sor
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;Mr.Pertto.niuch,I?,Mr. Peritq. Tha
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328Chairman Pepper. Mr. Steiger.Mr.
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, Mr., In''wMr, WiNx.nltiiink tlie
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:332"Stomach cramps" were found to
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'i.We334'""^li'anTOanl^ETPPEiL That
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:))))336would be deprived of any cl
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338less abuse liability than agents
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CONTENTSApril 26 1April 27 77April
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:•vEXHIBIT NO. 4 (a) AND (b)Eddy,
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:lovernor,vnEXHIBIT NO. 21 (a) and
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342have no desire to preempt the au
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344We hope these hearings will prov
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346tons in 1962 and to 155 tons in
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348SOUTHEAST ASIAAs you know also,
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350I would also point out as I did
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352their farmers who have been grow
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354told that much of the insurgency
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356Mr. IxGERSOLL. Well, again, Mr.
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358jority of the heroin problem in
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360years, but I have been frustrate
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362Mr, Steiger. If you were goin^ t
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364report marihuana among junior gr
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366And it seems to me tliat we Avou
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?368effectively, then maybe we will
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370improvement as far as the abilit
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372was there. Your visits probably
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374the purchase of Avitnesses—I s
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:376administrations to publicly say
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378Chairman Pepper. We will take a
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380Mr. Ingersoll. No. I don't recal
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:382can fulfill the vow made by the
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384have to give you the same answer
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386Mr. Brasco. But that is another
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388Mr. Ingeksoll. Well, that is the
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Page 413 and 414:
-39,3,Dr. Edwards held a surgical f
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395of Narcotics and Dangerous Drugs
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397Naloxone, recently approved for
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399for example, who might be abusin
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401Now, because of our attention ha
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403and this is only for the investi
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405effects this drug will produce i
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407Now, if it is not used intravene
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409Mr. Wiggins. Dr. Jennings, does
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411Penicillin is good for pneumonia
Page 433 and 434:
413Mr. R ANGEL. But from the studie
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415Dr. Gardner. Again, we don't hav
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417Dr. Edwards. I suspect it at lea
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419On the other hand, if serious si
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421of the best known programs. Alth
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423Medical Association, American Ps
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425of the United States Pharmacopei
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4275. Repeated examinations. Physic
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429agement and rehabilitation of se
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—431As the agenc.v within HEW whi
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433and complex acts such as driving
Page 455 and 456:
435(Inig induces physical and psych
Page 457 and 458:
437Chiiirmtin Pepper. Doctor, I thi
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439A large proportion of youngsters
Page 461 and 462:
441Dr. Brown, what would you say is
Page 463 and 464:
443Chairmiui Pepper. Wliat is tlie
Page 465 and 466:
446The state of the art is promisin
Page 467 and 468:
447Lot nie ask you first, is tlic d
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449Chairman Pepper. Do you happen t
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451want you to take a look at. We w
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453In addition to that, there seems
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455the Mfldict is having a program
Page 477 and 478:
457—on drugs? By that I mean, vei
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459\\ e are basically saying, in or
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—;461that this is the extent to w
Page 483 and 484:
463We could go into the drug area a
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.465program that was i)ut into Jack
Page 487 and 488:
467Mr. Brasco. Possibly. However, w
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469him, arrange to get somebody els
Page 491 and 492:
471ainpheta.mines, or barbiturates.
Page 493 and 494:
473In the meantime, the Institute d
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475treated in the community centers
Page 497 and 498:
477research on narcotics in the sam
Page 499 and 500:
479c 53 03E
Page 501 and 502:
Page 503 and 504:
483spending for research through NI
Page 505 and 506:
485There has been no concerted seri
Page 507 and 508:
487it is left in one of their veins
Page 509 and 510:
489I do not think I should explain
Page 511 and 512:
491Dr. ViLLARREAL. Until the reflex
Page 513 and 514:
493evidence strongly shows is that
Page 515 and 516:
495Chairman Pepper. One other quest
Page 517 and 518:
497Dr. ViLLARREAL. So, it is a biol
Page 519 and 520:
'.499could result in a laboratory s
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5qifinds it in normal exploration.
Page 523 and 524:
503synthesized a large number of na
Page 525 and 526:
505STATEMENT OE DR. ALBERT KURLAND,
Page 527 and 528:
507discovered if we iiad taken the
Page 529 and 530:
509Mr. Perito. Dr. Kurland, do you
Page 531 and 532:
511Chairman Pepper. Has the Food an
Page 533 and 534:
513]Mr. Steiger. Do you feel from y
Page 535 and 536:
515In this second study there was a
Page 537 and 538:
517were any significant differences
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519The Deceptive Communication and
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.522than a State psychiatric hospit
Page 544 and 545:
524Department of Mental Hygiene), R
Page 546 and 547:
TABLE 3—COMPARISON OF THE 1ST POS
Page 548 and 549:
528TABLE 10—RELATIONSHIP OF AGE T
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530tution and his involvement in th
Page 552 and 553:
Attachment No. 5;r\ N-CH,-CH=CHo ,
Page 554 and 555:
'-534Chart No. U (case No. 672)Disp
Page 556 and 557:
536Chart No. 4 (case No. 694)Illust
Page 558 and 559:
538Chart No. 35 {case No. 697)Excep
Page 560 and 561:
540This amount of heroin is roughly
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5msuccessful or not in that short a
Page 564 and 565:
544Chairman Pepper. Would you repea
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54^creased amount of licit as well
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—54Sand the bureaucracy and the a
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,,Mr.550you have used some of the s
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552so many areas is also a pitiful
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55,4nitiide of heroin addiction in
Page 576 and 577:
556reached $976.5 billion, we can w
Page 578 and 579:
558Mr. Jones was appointed to the c
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560cant when you consider that Out
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562criminal act in his lifetime. Ye
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—564Mr. Perito. Would it be fair
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566Now, Dr. Cliambers, can yon resp
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—568Mr. Raxgel. Our distinguished
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;-570Mr. Jones. That is correct. Ou
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572the commissioner, $186 million i
Page 594 and 595:
574there should be something in the
Page 596 and 597:
576and the way in which the funds a
Page 598 and 599:
57SDr. Chambers. I think wliat you
Page 600 and 601:
580Education is the best way of pre
Page 602 and 603:
58-2Certain essential facts must re
Page 604 and 605:
584done through determined action,
Page 606 and 607:
586druffs, has the Nation's largest
Page 608 and 609:
:588To repeat, methadone maintenanc
Page 610 and 611:
:590I believe the Federal Governmen
Page 612 and 613:
:take no such satisfaction. We have
Page 614 and 615:
594of value in the testimony you ha
Page 616 and 617:
596gone ahead with several. We have
Page 618 and 619:
598force within our State Police De
Page 620 and 621:
60PRased on the proposed goal of 2.
Page 622 and 623:
602STATEMENT OF HON. MILTON SIIAPP,
Page 624 and 625:
(51)4and apprehend the wholesalers
Page 626 and 627:
J'606[Exhibit No. 23Prepared Statem
Page 628 and 629:
608Under our 1071-72 budget proposa
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GIOcenters for the treatment of her
Page 632 and 633:
. Dr.612Bourne informs me that we h
Page 634 and 635:
614Governors in Atlanta to which re
Page 636 and 637:
616pretty bad news, because it indi
Page 638 and 639:
618Scientific statistical ioformati
Page 640 and 641:
620((')) Finally, I believe that al
Page 642 and 643:
622Governor Carter. I certainly rec
Page 644 and 645:
624programs that are now available,
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626all of the top officials in the
Page 648 and 649:
628perhaps greater than some of the
Page 650 and 651:
)630tion and many others attempting
Page 652 and 653:
632(3) Long term residential self-h
Page 654 and 655:
634for the support of drug service
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:636D. NARCO, Inc.Narcotics Addicti
Page 658 and 659:
638crimes to obtain the necessary m
Page 660 and 661:
640million to $25 milliou per year.
Page 662 and 663:
642Mr. Perito. Thank yoii. Mr. Chai
Page 664 and 665:
644narcotic antagonist, and the oth
Page 666 and 667:
646. Dr. Kramer. From what I have s
Page 668 and 669:
—(348your money on, but methadone
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—650I know of no techinque in pri
Page 672 and 673:
652Dr. Kramer. Yes, sir. As a matte
Page 674 and 675:
:'654prison and who liave no—wlio
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65GDr. KT?A:\rEij. 1 suspect tliat
Page 678 and 679:
658support some of the inethadone p
Page 680 and 681:
'6660Dr. IvKAisrKK. 1 believe that
Page 682 and 683:
662jrest that the Veterans' Adminis
Page 684 and 685:
664opiates may be ingested in sever
Page 686 and 687:
666(5) It suppresses the desire for
Page 688 and 689:
668Many people have benefited from
Page 690 and 691:
—G70Other researches which may di
Page 692 and 693:
672synthetic painkillers, our commi
Page 694 and 695:
074IV. A universal ban on legitimat
Page 696 and 697:
..676iTlius we must look to educati
Page 698 and 699:
678states, from Arnold Becker, publ
Page 700 and 701:
680However, we must look at rehabil
Page 702 and 703:
:682(a) The natural history of narc
Page 704 and 705:
684was a heavy user. The decrease i
Page 706 and 707:
686(13) Wallace. R. K. : Physiologi
Page 708 and 709:
688TABLE 9.-USE OF "HARD LIQUOR" BE
Page 710:
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